The indictment of a Detroit area sham therapy operation was announced this summer, and in a United States Department of Justice (USDOJ) press release on Monday, the main conspirator plead guilty to a $18.2 million scheme to defraud the Medicare program.  According to the DOJ press release

“…Chand admitted that in order to create the false therapy files, he and his co-conspirators paid cash kickbacks and other inducements to Medicare patients in exchange for their Medicare numbers and signatures. Chand acknowledged recruiting hundreds of Medicare patients, and paying them with cash and prescriptions for Vicodin and Xanax. Chand admitted that he obtained the prescriptions for these drugs from a physician who had never seen the patients. Chand also admitted that he prepared false prescriptions and files for the physician’s signature. ……. Chand admitted that he and others would obtain signatures from licensed therapists on false progress notes indicating that the therapists had provided therapy, when they had not. Chand admitted that the licensed therapists were paid to help falsify the files.”

In the therapy community we have become incensed with the blantant misuse of the outpatient therapy process to defraud the Medicare system, particularly since most of these fraduent schemes have operated without the complicity of licensed physical and occupational therapists.  In this scheme the conspirator indicated that part of his scheme, in addition to paying beneficiaries to use their Medicare number, that physical therapists were enlisted and paid to falsify the plan of care documents.

Attorney General Eric Holder and Health and Human Services (HHS) Secretary Kathleen Sebelius have jointly announced the creation of a new fraud initiation called HEAT:  the Health Care Fraud Prevention and Enforcement Action Team.  The expansion of  the Medicare Strike Force team operations to Detroit and Houston was also announced.  Medicare Fraud Strike Forces are currently operating in South Florida and Los Angeles and have been enormously successful.

A new website Stop Medicare Fraud has also been revealed.

According to the website stopping those who perpetrate fraud includes:

• Continuing to utilize Strike Force teams that fight fraud in Miami and Los Angeles;
• Creating Strike Force teams in Detroit and Houston; and
• Helping State Medicaid officials conduct provider audits and monitor activities to detect fraudulent activities.
• Using modern technology to complete in a matter of days analysis of electronic evidence that previously took months to analyze using traditional investigative tools.
• Background on the Health Care Fraud Prevention and Enforcement Action Team
• Criminal Prosecution as a Deterrent to Health Care Fraud (PDF – 89 KB), Testimony of Lanny Breuer, Assistant Attorney General for the Criminal Division, before the Senate Judiciary Committee’s Subcommittee on Crime and Drugs, 5/20/2009

The website will also be tracking fraud efforts as well as providing information to the public on how they can report suspected fraud.